ZuZu, You have a GP managing chronic pain. If you need a PM doc then you may have to travel or relocate. As far as the percs, your on step two of dozens of options with long acting versions of oxy, morphine, fentanyl patches, methadone, long acting dilaudid, short acting dilaudid and you are corect, Purdue makes OxyIR in 10 and 20 mg tablets that contain no tylenol. However you can't really expect your GP to manage CP that requires meds that would have only been prescribed for cancer just 10 years ago. All the LA meds and the high strength pure opiates have all come out in the last 5-10 years, Newer ones hit the market each year. You simply can't expect a GP to be versed in PM and all the alternatives.
So what happens when you tolerant to 600 mgs of long acting morphine a day and 30 mg Oxycodone tablets barely touch the pain? You can have an intrathecal morphine pump implanted, that's when no other method of pain management is effective or the side effects of other meds are too severe to manage your problem. It sounds like the only method of pain management you have been exposed to is the pain meds your GP is willing to prescribe. Prior to 96 and the invention of long acting pure opiates, PM docs used other methods to manage pain, some help, some are a waste of time and some resolve some peoples roblems entirely.
You have to look at this as how your going to spend the rest of your life. If you had cancer, you wouldn't except a death sentance from your loocal GP because he was trained in oncolog., You're basically facing the same thing. Honestly , you probably shouldn't jump on the increrase train and jack your tolerance through the roof untill you have explored some options that don't result in dependence on opiates.
There really is no ceiling on the amount of pure opiate one person can take. The ceiling is created by the side effects, Too sedating, too much urinary retention, too constipating, too much nausea, or the docs own discomfort with high dose patients. Side efects do deminish with time, a couple of increases in morphine and some time to adjust to the side effets may have allowed morphine to be a viable option. However, your doc claims not to even be aware they make a drug stronger than percs, so it's time to start looking into real PM if you need these meds to function.
It's not like these meds are harmless though, There is a price to be paid for everything. Physical dependence is a huge priice, and dependence on 6 percs a day is nothing compared to seveeral hundred mgs of long acting pure opiate.
600 mgs of morphine may sound like alot, but it's the difference between being able to walk and being bed ridden for me, It's not a matter of comfort. There is no dose that would eliminate all my pain or even rekieve more than half my pain without sedating me. Honestly there are days I wish I could be sedated. All you have done is see the limits of your own GP and know you need a specialist if you can't manage with what he has to offer.
Even among PM docs, not every doc can offer every modality.Some use opiates, some don't,some do interventional procedures and some simply write scripts. There are dozens of non opiate methods to manage chronic pain. Opiates are the easiest solution, but come with a huge price. In Canada, you have to have a special licence to prescribe methadone which can be very effective, It's not the next step on the ladded but it's something out there your present doc will never be able to offer. He'll never offer an implanted morphine pump or a spinal cord stim, can he teach you self hypnsosis, Bio feedback or guided imagry? Does he use anti seizure meds and anti depressant for their chemical effect.
The same goes for techniques uswed by real PM docs. Not every PM doc can or will offer Interventional procedures like nerve blocks, epidurals, trigger point injections, use of Botox or even surgery if that may bring relief. Your doc isn't a PM doc so he will not be offering anything he's not familiar with. If you needed surgery or had cancer, he would admit his limitations, He's simply not comfortable prescribing more than 6 percs a day. He does want to say that's his personal limit, he's just saying he won't prescribe more than that.
That's his choice, but you have the option of seeking more qualified help.
If someone will only participate in PM if it's conveinant, doesn't interfer with their life or have to drive more than 30 minutes, It's hard to call that life altering pain that requires the most potent meds and most agressive methods to treat pain. If your pain is that severe, you will travel or be bed ridden or simply more uncomfortable than you are now once you grow more tolerant.
The only real limit you have run into so far is local doc selection and his willingness to prescribe stronger meds. Perhaps he wants you to go find a PM doc with a background in anesthesia so he can try some of the non opiate interventional procedures. Traveling sucks, but it's better than allowing pain to manage your life rather than you manging the pain.
It's not that your docs a bad guy, He just doesn't want to test his prescribing limits on the few patient he may presently be helping. If percs are the strongest thing he uses, I kind of doubt he's going to prescribe fentanyl loli pops that are a hundred times more potent than percocet.
Good luck and you may be surprised by all the options true PM docs can offer.
Take care, Dave